Low Back Pain CoachHome / How it works
A loaded 45-degree back-extension progression, and the mental side of persistent pain.
You train your back on a 45-degree bench and add a little over weeks. You judge each session by how your back feels the next morning. At the same time you deal with the fear that you will never get better.
This is for chronic low back pain that has stubbornly stayed for months, if not years. If you had a recent acute injury or surgery in the past few months, finish the recovery plan your clinician set before you start a loading program.
The bench
You do the program on a 45-degree back-extension bench. The pad rests against the top of your thighs at the hip crease, your ankles lock under a roller, and you lean forward over the pad. Many gyms have one, and folding home models cost roughly $70 to $160. A vertical 90-degree chair is a different machine, and the program is not written for it.
Holds first, then a small range, then full-range reps with your body weight, then a plate at your chest. Change one thing at a time. I started smaller than I wanted to and added only when the next morning said I could. Doing too much cost me bad days, and doing too little changed nothing.
From Stage 2 on, let your back round on the way down and straighten as you come up. You are moving the spine, not holding it stiff and folding only at the hips.
This program requires a bench. If you do not have one yet, start on the floor today: a prone hold, bird-dogs, and glute bridges. You can start Stage 1 the day you confirm you have a bench, unless a flare or a leg-pain stop is on. If you already said in the setup questions that you have a bench and you are still on the floor, the app moves you on by itself only when each of your last three floor training days has a prone hold of about 30 seconds (or 90 seconds of holding in total; partial sessions do not count), your pain is logged on at least 3 of the past 7 days with none above your usual or in your legs, and your next-morning check-ins allow a step up.
The next morning
Write down what your back usually feels like on an ordinary day, from 1 to 10. That is the baseline.
After a session, wait until the next morning and compare. A next-morning check-in below your baseline steps the dose up. One at your baseline repeats the session, unless the previous training day's next-morning check-in was also at or below your baseline. A check-in higher than the pain you logged before that session does not count. One above your baseline makes the next session smaller: less time, fewer reps, less range, or less weight. Pain that runs into your legs means stop the extension work.
The morning log grades work you already did. It does not predict how today will go, so do not skip a session because you expect a bad morning.
Sleep, stress, and a long day on your feet can move a single score. Look at a few sessions in a row before you change course.
The mental side
For years my back was the first thing I thought about in the morning and the last thing at night. I almost did not want to get out of bed, even though staying there made it worse. My energy dropped. I got more irritable and less patient, and that general negativity made it hard to change anything.
Under it was the fear that I would never get better, and the hopelessness that the pain would control my life from here on. In my experience the two fed each other, and the days I gave in to them were worse days for my back.
Someone who has hurt for years has usually stopped training the back. Mine got weak and tight. Keep the training.
After about an hour of standing or walking, the rest of my day used to be shot. On a long trip abroad I hunted benches and hunched on the ground to stretch. A walking routine helps you get comfortable on your feet again. Loading the back extension is the program.
That is my experience. Yours may go differently, and the guides say where the research stops.
The app
I built Low Back Pain Coach to hold the timers, the log, and the next session in one place. It reads your recent sessions and next-morning logs and writes the next workout. A notebook still works if you would rather run those decisions yourself.